The Impact of the COVID-19 Pandemic and Associated Control Measures on the Mental Health of the General Population
Authors: Georgia Salanti, Natalie Peter, Thomy Tonia, Alexander Holloway, Ian R. White, Leila Darwish, Nicola Low, Matthias Egger, Andreas D. Haas, Seena Fazel, Ronald C. Kessler, Helen Herrman, Christian Kieling, Dominique J.F. De Quervain, Simone N. Vigod, Vikram Patel, Tianjing Li, Pim Cuijpers, Andrea Cipriani, Toshi A. Furukawa, Stefan Leucht, Abdulkadir Usman Sambo, Akira Onishi, Akira Sato, Alessandro Rodolico, Ana Cristina de Oliveira Solis, Anastasia Antoniou, Angelika Kapfhammer, Anna Ceraso, Aoife O’Mahony, Aurélie M. Lasserre, Aziz Mert Ipekci, Carmen Concerto, Caroline Zangani, Chinonso Igwesi-Chidobe, Christina Diehm, Dicle Dilay Demir, Dongfang Wang, Edoardo Giuseppe Ostinelli, Ethan Sahker, Gabriel Henrique Beraldi, Gamze Erzin, Harrison Nelson, Helio Elkis, Hissei Imai, Hui Wu, Ilias Kamitsis, Ioannis Filis, Ioannis Michopoulos, Irene Bighelli, James S.W. Hong, Javier Ballesteros, Katharine A. Smith, Kazufumi Yoshida, Kenji Omae, Marialena Trivella, Masafumi Tada, Matthias A. Reinhard, Michael J. Ostacher, Monika Müller, Nathalia Gonzalez Jaramillo, Panagiotis P. Ferentinos, Rie Toyomoto, Samuele Cortese, Sanae Kishimoto, Sergio A. Covarrubias-Castillo, Spyridon Siafis, Trevor Thompson, Vasilios Karageorgiou, Virginia Chiocchia, Yikang Zhu, Yukiko Honda, Abdulkadir Usman Sambo, Akira Onishi, Akira Sato, Alessandro Rodolico, Ana Cristina de Oliveira Solis, Anastasia Antoniou, Angelika Kapfhammer, Anna Ceraso, Aoife O’Mahony, Aurélie M. Lasserre, Aziz Mert Ipekci, Carmen Concerto, Caroline Zangani, Chinonso Igwesi-Chidobe, Christina Diehm, Dicle Dilay Demir, Dongfang Wang, Edoardo Giuseppe Ostinelli, Ethan Sahker, Gabriel Henrique Beraldi, Gamze Erzin, Harrison Nelson, Helio Elkis, Hissei Imai, Hui Wu, Ilias Kamitsis, Ioannis Filis, Ioannis Michopoulos, Irene Bighelli, James S.W. Hong, Javier Ballesteros, Katharine A. Smith, Kazufumi Yoshida, Kenji Omae, Marialena Trivella, Masafumi Tada, Matthias A. Reinhard, Michael J. Ostacher, Monika Müller, Nathalia Gonzalez Jaramillo, Panagiotis P. Ferentinos, Rie Toyomoto, Samuele Cortese, Sanae Kishimoto, Sergio A. Covarrubias-Castillo, Spyridon Siafis, Trevor Thompson, Vasilios Karageorgiou, Virginia Chiocchia, Yikang Zhu, Yukiko Honda
Journal: Annals of Internal Medicine (2022)

Background: To what extent the COVID-19 pandemic and its containment measures influenced mental health in the general population is still unclear. Purpose: To assess the trajectory of mental health symptoms during the first year of the pandemic and examine dose–response relations with characteristics of the pandemic and its containment. Data Sources: Relevant articles were identified from the living evidence database of the COVID-19 Open Access Project, which indexes COVID-19–related publications from MEDLINE via PubMed, Embase via Ovid, and PsycInfo. Preprint publications were not considered. Study Selection: Longitudinal studies that reported data on the general population's mental health using validated scales and that were published before 31 March 2021 were eligible. Data Extraction: An international crowd of 109 trained reviewers screened references and extracted study characteristics, participant characteristics, and symptom scores at each timepoint. Data were also included for the following country-specific variables: days since the first case of SARS-CoV-2 infection, the stringency of governmental containment measures, and the cumulative numbers of cases and deaths. Data Synthesis: In a total of 43 studies (331 628 participants), changes in symptoms of psychological distress, sleep disturbances, and mental well-being varied substantially across studies. On average, depression and anxiety symptoms worsened in the first 2 months of the pandemic (standardized mean difference at 60 days, −0.39 [95% credible interval, −0.76 to −0.03]); thereafter, the trajectories were heterogeneous. There was a linear association of worsening depression and anxiety with increasing numbers of reported cases of SARS-CoV-2 infection and increasing stringency in governmental measures. Gender, age, country, deprivation, inequalities, risk of bias, and study design did not modify these associations. Limitations: The certainty of the evidence was low because of the high risk of bias in included studies and the large amount of heterogeneity. Stringency measures and surges in cases were strongly correlated and changed over time. The observed associations should not be interpreted as causal relationships. Conclusion: Although an initial increase in average symptoms of depression and anxiety and an association between higher numbers of reported cases and more stringent measures were found, changes in mental health symptoms varied substantially across studies after the first 2 months of the pandemic. This suggests that different populations responded differently to the psychological stress generated by the pandemic and its containment measures. Primary Funding Source: Swiss National Science Foundation. (PROSPERO: CRD42020180049)